title: ADad 2: the validation of the Screen for Child Anxiety Related Emotional Disorders for Anxiety Disorders among adolescents in a rural community population in India.
abstract: OBJECTIVE
  Screen for Child Anxiety Related Emotional Disorders (SCARED), a measure found useful in different settings and cultures has not been validated in the subcontinent. This study validated this measure for identifying Anxiety Disorder (AD) among adolescents in an Indian community context.
  
  
  METHODS
  Five hundred adolescents were assessed with SCARED and DSM-IV-TR reference standard for diagnosis of AD. The interviewers were experienced raters who were further trained to interview participants using Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL). Sensitivity, specificity, likelihood ratios and predictive values for various SCARED cut-off scores were calculated. Test-retest reliability and inter-rater reliability of SCARED were examined. The dichotomized SCARED score was correlated with the DSM-IV-TR clinical diagnosis of AD to establish the criterion validity of SCARED as a measure of AD.
  
  
  RESULTS
  A SCARED total score of ≥21(Sn = 84.62%, Sp = 87.36%; AUC = 90%) is suggested for diagnostic use in Indian population. Specific threshold scores were identified for the Panic Disorder, Generalized Anxiety Disorder, Separation Anxiety Disorder and Social Anxiety Disorder subscales. The inter-rater reliability (ICC = 0.87) and test-retest reliability (ICC = 0.90) for SCARED is good. Besides the adequate face and content validity, SCARED demonstrates good internal consistency (Cronbach's α = 0.89) and item-total correlation. There is a high concordance rate with the reference standard, DSM-IV-TR diagnosis [81%; Cohen's κ = 0.42 (95% CI = 0.31 to 0.52); P = 0.001] in classifying AD.
  
  
  CONCLUSIONS
  SCARED has adequate psychometric properties and is now available for clinical and research work in India.
authors.affiliation: Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore, 632 002, Tamil Nadu, South India, russell@cmcvellore.ac.in.
authors.forename: Paul Swamidhas Sudhakar
authors.initials: PS
authors.lastname: Russell
authors.forename: M K C
authors.initials: MK
authors.lastname: Nair
authors.forename: Sushila
authors.initials: S
authors.lastname: Russell
authors.forename: Vinod Shanmukham
authors.initials: VS
authors.lastname: Subramaniam
authors.forename: Anupama Zeena
authors.initials: AZ
authors.lastname: Sequeira
authors.forename: Suma
authors.initials: S
authors.lastname: Nazeema
authors.forename: Babu
authors.initials: B
authors.lastname: George
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis*; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D012423:Rural Health; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D055815:Young Adult